Diversidade de nematoides em sistemas de uso do solo nos biomas de mata atlântica e caatinga e aspectos taxonômicos e filogenéticos da família Telotylenchidae

Tese (doutorado)—Universidade de Brasília, Instituto de Ciências Biológicas, Departamento de Fitopatologia, Programa de Pós-Graduação em Fitopatologia, 2015.Os nematoides são animais invertebrados pertencentes ao filo Nematoda. Vários índices e outros sistemas de mensurações ecológicas foram criados ou adaptados para explorar o potencial dos nematoides como bioindicadores de alterações ambientais e qualidade do solo. As comunidades de nematoides que habitam o solo são compostas por cinco grupos principais: parasitas de plantas, bacteriófagos, micófagos, predadores e onívoros, sendo que em solos cobertos por vegetação, geralmente os parasitas de plantas são os mais abundantes, com destaque para os membros da subordem Tylenchina, um dos grupos mais diversificados e de maior importância econômica em escala global. A taxonomia de nematoides se baseia principalmente em dados morfológicos e morfométricos. Como consequência do uso isolado destes caracteres, os sistemas de classificação dos nematoides têm sido efêmeros e não refletem com fidelidade as relações filogenéticas entre os táxons. A integração de caracteres morfológicos com dados moleculares, principalmente sequências dos genes do DNA ribossômico (rDNA), têm provocado profundas mudanças na interpretação da filogenia dos nematoides. O objetivo geral deste estudo foi contribuir para o incremento dos conhecimentos em biodiversidade de nematoides de solo, assim como aspectos taxonômicos de nematoides da subordem Tylenchina, pertencentes ao gêneroTylenchorhynchus e outros gêneros afins de várias regiões geográficas do mundo. Os objetivos específicos se basearam em proceder inventário da biodiversidade de nematoides em áreas naturais e cultivadas da Caatinga, na região do Vale do São Francisco, Petrolina-PE, como também em extinta área de mineração da empresa Vale S.A, convertida no “Centro de Pesquisas e Conservação da Biodiversidade do Quadrilátero Ferrífero” (CeBio), localizado no bioma Mata Atlântica; buscar indicadores na comunidade de nematoides que possam ser empregados na avaliação das condições ecológicas do solo nessas áreas; combinar indicadores de impactos ambientais resultantes das comunidades de nematoides com outros indicadores resultantes de propriedades físicas e químicas do solo, visando uma melhor compreensão dos fatores que afetam a qualidade do solo; e, por fim, proceder estudos filogenéticos comparativos levando em consideração aspectos morfológicos, morfométricos e moleculares de populações de nematoides do gênero Tylenchorhynchus e outros gêneros afins do Brasil e de outras regiões do mundo. Como resultados, nas áreas da Caatinga, a retirada da vegetação nativa e a implantação dos cultivos de fruteiras e forrageiras influenciou as comunidades de nematoides, suprimindo a presença de alguns nematoides e promovendo a introdução de outros nas áreas cultivadas. Os índices ecológicos mostraram-se eficientes na indicação de distúrbios no solo, assim como atributos do solo, tais como textura, acidez, matéria orgânica, micro e macro nutrientes, os quais desempenharam papéis essenciais na definição da estrutura da comunidade de nematoides do solo nos diferentes sistemas avaliados. Nas áreas do “CeBio”, foi demonstrado que a nematofauna respondeu às mudanças na cobertura vegetal do solo e às variações abióticas. O método multivariado de Análise de Componentes Principais mostrou-se eficiente no estudo das comunidades de nematoides. Os estudos filogenéticos comparativos levando em conta critérios morfológicos e moleculares advindos da avaliação de sequências do gene 28S do rDNA estabeleceu a importância do uso da identificação taxonômica integrativa na caracterização dos nematoides. Os dados obtidos neste estudo mostram uma tendência à monofilia da família Telotylenchidae, separando a subfamília Merliniinae da Telotylenchinae, portanto, indicando a necessidade de revisão do sistema vigente de classificação desta família, proposto por Siddiqi (2000).Nematodes are invertebrates belonging to the phylum Nematoda, one of the most abundant and diverse groups of animals on the planet. Due to the short life cycle and the different trophic habits, soil nematodes can reflect environmental changes, altering the structure and community composition. These are some of the features that qualify them as environmental biomarkers. Several indices and other ecological measurement systems were created or adapted to explore the potential of nematodes as bio-indicators of environmental changes and soil quality. The soil nematode communities are composed of five main trophic groups: plant parasites, bacterial feeders, fungal feeders, predators and omnivores. In plant covered soils, usually plant-parasitic nematodes are the most abundant, among them stand out members of the suborder Tylenchina. Tylenchina is one of the most diverse and economically important groups on a global scale, and nematological studies in Brazil indicate a wide variety of members of this suborder. Nematode taxonomy is based mainly on morphological and morphometric characters. As a result of isolated use of these characters, the systems of nematode classification have been ephemeral, and do not reflect faithfully the phylogenetic relationships among taxa. The integration of morphological characters with molecular data, especially sequences of genes of ribosomal DNA (rDNA), has caused profound changes in the interpretation of nematode phylogeny. Therfore, the overall objective of the study was to contribute to the knowledge on the biodiversity of soil nematodes in the Atlantic Forest and Caatinga biomes, and on the taxonomic aspects of nematodes of the suborder Tylenchina, with focus on Tylenchorhynchus and related genera, from Brazil and several world geographic regions. The specific objectives aim to conduct inventories of nematode biodiversity in an extinct mining area of Vale Mining Company, now converted to the Centre for Research and Biodiversity Conservation of the Iron Quadrangle (CeBio), as well as in natural and cultivated areas of Caatinga biome in the region of Vale do São Francisco, Petrolina-PE. Both benchmark sites were under different levels of human intervention; to look for indicators on the nematode community that can be used to assess the soil ecological conditions in these areas; to combine indicators of environmental impacts from the nematode communities with other indicators resulting from physical and chemical properties of the soil, to improve knowledge on the factors affecting soil quality; to conduct comparative phylogenetic studies taking into account morphological, morphometric and molecular approaches of nematode populations of Tylenchorhynchus and related genera. Results indicated that in the areas of Caatinga, replacing native vegetation by fruit trees and forage crops influencednematode communities, suppressing the presence of some nematodes and the introduction of other ones in cultivated area.The environmental indices were effective in indication of soil disturbancelevels, as well as soil characteristics, such as texture, acidity, soil organic matter, micro and macro nutrients, wich have played essential roles in defining structure of soil nematodes communities. In areas of CeBio it was demonstratedthatthe nematode assemblages respondedto changes in vegetation cover and soil abiotic factors. The multivariate method of Principal Component Analysis was an efficient tool in the study of nematode communities. The comparative phylogenetic studies taking into account morphological and molecular criteria, established the importance of using integrative taxonomic approach on the characterization of nematodes. The data indicate a tendency to monophyly of the family Telotylenchidae, separating the subfamily Merliniinae of Telotylenchinae, which indicates that the current system of classification proposed by Siddiqi (2000) needs to be revised

Pochonia chlamydosporia, Gracilibacillus dipsosauri e condicionador de solo para o controle de Meloidogyne javanica em tomateiro

A matéria orgânica exerce papel fundamental na atividade antagonista de microrganismos sobre populações de fitonematoides no solo. Nesse trabalho foram avaliados a compatibilidade entre o fungo Pochonia chlamydosporia (Pc-12) e a rizobactéria Gracilibacillus dipsosauri (MIC 14) in vitro e o efeito deste fungo a 5000 clamidósporos/g de solo, da rizobactéria a 4,65 x 10(9) células/g de solo, e do condicionador de solo Ribumin® a 10 g/vaso, isoladamente ou em conjunto, sobre Meloidogyne javanica em tomateiro (3000 ovos/vaso). Uma suspensão de água ou apenas Ribumin®, foi aplicada ao solo como testemunhas negativas, enquanto uma suspensão de ovos do nematoide foi aplicada como controle positivo. A redução no número de galhas em raízes por planta foi de 48 e 41% nos tratamentos Ribumin + MIC 14 + Pc-12 e MIC 14 + Pc-12, respectivamente. Quanto ao número de ovos por planta, MIC 14 e Pc-12 + Ribumin proporcionaram redução de 26 e 21% respectivamente em relação ao tratamento testemunha. A interação entre o fungo nematófago e a rizobactéria foi positiva para o controle do nematoide, apesar do fato de G. dipsosauri ter inibido o crescimento do fungo P. clamidosporia em até 30% em teste in vitro.Organic matter plays a fundamental role in the antagonistic activity of microorganisms against phytonematode populations on the soil. In this study, the compatibility between the fungus Pochonia chlamydosporia (Pc-12) and the rhizobacterium Gracilibacillus dipsosauri (MIC 14) was evaluated in vitro, as well as the effect of the fungus at the concentration of 5,000 chlamydospores per gram of soil, rhizobacterium at 4.65 x 10(9) cells/g of soil, and the soil conditioner Ribumin® at 10 g/pot, either alone or in combination, against Meloidogyne javanica population in tomato plants (3,000 eggs/pot). A suspension of water or Ribumin® alone was applied on the soil as negative control, while a suspension of nematode eggs was applied as positive control. The reduction in the number of galls in roots per plant was 48 and 41% for the treatments Ribumin + MIC 14 + Pc-12 and MIC 14 + Pc-12, respectively. Regarding to the number of eggs per plant, MIC 14 and Pc-12 + Ribumin led to a reduction by 26 and 21%, respectively, compared to the control treatment. Interaction between the nematophagous fungus and the rhizobacterium was positive for the nematode control, even though G. dipsosauri inhibited P. chlamydosporia growth by up to 30% in in vitro tests

EFEITOS DO HIPOTIREOIDISMO CONGÊNITO NO DESENVOLVIMENTO CEREBRAL: IMPACTO NA COGNIÇÃO, COMPORTAMENTO E DESENVOLVIMENTO PSICOMOTOR.

Congenital hypothyroidism is an endocrine condition characterized by partial or complete deficiency of thyroid hormones at birth. These hormones play a crucial role in the development of the central nervous system. The lack of these hormones can lead to neurological and cognitive disorders. Untreated congenital hypothyroidism is associated with cognitive deficits, learning difficulties, memory issues, attention problems, language skills, and behavioral challenges. Methodology: The research was conducted by accessing online scientific databases such as Google Scholar, National Library of Medicine (PubMed), Virtual Health Library (BVS), and Scientific Electronic Library Online (SCIELO) to select relevant articles using keywords related to Cognition, Behavior, Brain Development, Psychomotor Development, Congenital Hypothyroidism, Early Intervention, Hormone Replacement Therapy, and Neonatal Screening. Results: The research emphasizes the relationship between delayed treatment initiation and significant cognitive, behavioral, and psychomotor deficits, highlighting the importance of neonatal screening and immediate intervention. It also identifies a critical treatment window within the first weeks of life when the brain is rapidly developing and sensitive to hormonal deficiency. Furthermore, it underscores the influence of thyroid hormones on behavior, emotions, and motor development, emphasizing the need for early hormone replacement therapy and multidisciplinary follow-up. Final Considerations: Congenital hypothyroidism is a serious condition that requires a team of different specialists to ensure the best possible outcome for affected children.O hipotireoidismo congênito é uma condição endócrina caracterizada pela deficiência parcial ou total dos hormônios tireoidianos ao nascer. Esses hormônios desempenham um papel crucial no desenvolvimento do sistema nervoso central. A falta desses hormônios pode levar a distúrbios neurológicos e cognitivos. O hipotireoidismo congênito não tratado está associado a déficits cognitivos, problemas de aprendizagem, memória, atenção, habilidades linguísticas e comportamentais. Metodologia: A pesquisa foi realizada através do acesso online nas bases de dados científicos como: Google Scholar, National Library  of Medicine(PubMed), Biblioteca Virtual em Saúde (BVS) e Scientific  Electronic  Library  Online(SCIELO) para seleção dos artigos, através de palavras-chave presentes nos descritores Cognição, Comportamento, Desenvolvimento Cerebral, Desenvolvimento Psicomotor, Hipotireoidismo Congênito, Intervenção Precoce, Terapia de Reposição Hormonal, Triagem Neonatal. Resultados: A pesquisa enfatiza a relação entre o início tardio do tratamento e deficiências cognitivas, comportamentais e psicomotoras significativas, destacando a importância da triagem neonatal e da intervenção imediata. Além disso, aponta uma janela crítica para o tratamento nas primeiras semanas de vida, quando o cérebro está em desenvolvimento acelerado e sensível à deficiência hormonal. Também destaca a influência dos hormônios tireoidianos no comportamento, emoções e desenvolvimento motor, com a necessidade de terapia de reposição hormonal precoce e acompanhamento multidisciplinar. Considerações Finais: O hipotireoidismo congênito é uma condição séria que precisa de uma equipe de diferentes especialistas para garantir o melhor resultado possível para as crianças afetadas

Produção de clamidósporos de Pochonia chlamydosporia em diferentes substratos

Clamidósporos são estruturas de sobrevivência do fungo nematófago Pochonia chlamydosporia. Objetivou-se, com este trabalho, avaliar diferentes substratos, teores de água e formas de inóculo para a produção in vitro de clamidósporos de P. chlamydosporia. Inicialmente, testaram-se os substratos grãos de milho triturado, grãos de arroz e casca de café e os tipos de inóculo meio líquido concentrado ou diluído (1:40) e discos de cultura, colonizados por P. chlamydosporia. Posteriormente, testou-se o substrato grãos de milho triturado suplementado ou não com caldo de batata com os inóculos do fungo nas formas de discos de micélio ou suspensão aquosa. As maiores produções de clamidósporos g-1 de substrato foram obtidas nos substratos grãos de milho triturado e casca de café, e as melhores formas de inóculo foram meio líquido diluído (1:40) e discos de micélio. A suplementação do substrato grãos de milho triturado com caldo de batata não aumentou a produção de clamidósporos do fungo e a melhor forma de inóculo do fungo foi a de discos de micélio. Além disso, testaram-se os substratos canjica, grãos de arroz, casca de café e fibra de coco, umedecidos com diferentes quantidades de água; o substrato casca de café umedecido por diferentes períodos; a casca de café enriquecida ou não com sacarose e farinha de arroz e o substrato grãos de arroz esterilizado no forno micro-ondas com diferentes quantidades de água. Apenas o substrato grãos de arroz, em todas as quantidades de água testadas, apresentou maior produção de clamidósporos. Não houve diferença na produção de clamidósporos no substrato casca de café umedecido por diferentes períodos e apenas quando a casca de café foi enriquecida com farinha de arroz, apresentou maior média de clamidósporos g-1 de substrato. Todos os tratamentos apresentaram grande produção de clamidósporos g-1 quando o substrato utilizado foi o de grãos de arroz tratados no forno de micro-ondas. O melhor meio de cultivo de P. chlamydosporia para a produção de clamidósporos foi o substrato contendo grãos de arroz.Chlamydospores are survival structures of the nematophagous fungus Pochonia chlamydosporia. The objective of this study was to evaluate different substrates, different contents of water and kinds of inoculum for the production of Pochonia chlamydosporia chlamydospores. The substrates evaluated were: milled maize, rice grains and coffee husk; all of them were inoculated with disks of culture, concentrated liquid media or diluted liquid media (1:40) colonized by P. chlamydosporia. Besides, the substrates milled maize, supplemented or not with potato broth, and inoculated with fungus disks or aqueous suspension were evaluated. Milled maize and coffee husk were the best substrates for chlamydospores production. The best inoculum kinds were disks of culture and diluted liquid media (1:40) colonized by P. chlamydosporia. The supplementation of milled maize with potato broth did not improve the production of chlamydospores, and the best inoculum form was disks of fungus. Moreover, it was also studied the substrates rice grains, coffee husk and coconut fibers with different rates of water; the substrate coffee husk moistened by different periods; the supplementation of coffee husk with rice flour or dextrose; and the substrate grains of rice sterilized in microwave oven with different rates of water. The substrate grains of rice, in all of the amounts of water tested showed increase in production of chlamydospores. There was no difference in the chlamydospores production of the coffee husk substrate, when moistened by different periods of time and only when it was supplemented with rice flour it showed higher mean of clamydospores per gram of substrate. All treatments evaluated showed higher production of chlamydospores in the substrate grains of rice treated in the microwave oven. The best substrate for the production of chlamydospores of P. chlamydosporia was the rice grains

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity